Provider Demographics
NPI:1619095627
Name:OLMO, JAIME JR (LSA)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:OLMO
Suffix:JR
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5703 LAKESHORE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4297
Mailing Address - Country:US
Mailing Address - Phone:713-598-1919
Mailing Address - Fax:832-471-6044
Practice Address - Street 1:5703 LAKESHORE VISTA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4297
Practice Address - Country:US
Practice Address - Phone:713-598-1919
Practice Address - Fax:832-471-6044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00184246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist